Transitioning to outcomes-based healthcare is an industry wide goal. While some health systems, such as Texas Children’s Hospital, are in the process of making the switch (and doing it successfully), many systems don’t even know where to begin. Despite the challenges of achieving outcomes-based healthcare, it is essential for surviving the transition from fee-for-service (FFS) to value-based care. Systems can overcome the top three challenges associated with making the switch (lack of analytics, lack of access to information, and inappropriate organizational structure) by focusing on the most important success factors: Analytics Multidisciplinary Teams Armed with an enterprise data warehouse (EDW) to make data-driven decisions about the best outcomes improvement goals to pursue, and permanent multidisciplinary teams responsible for continuously improving care, systems can start making the switch to outcomes-based healthcare.

1. The Top Success Factors for Making the
Switch to Outcomes-Based Healthcare
̶ Dr. Bryan Oshiro

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There is something healthcare leaders can agree on: health systems
need to embrace outcomes-based healthcare in order to survive the
transition to value-based care. This presentation takes a closer look
at outcomes-based healthcare and what it really entails.
Outcomes-based healthcare
Despite the popularity of the outcomes-
based healthcare discussion, a standard
definition has not been found.
One possible explanation is outcomes-
based healthcare’s scope; it encom-
passes a vast spectrum of strategies
used to transition from fee-for-service
(FFS) to value-based care.

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Why Outcomes-Based Healthcare Is The Ultimate Goal
Historically, U.S. healthcare has been more
reactive than proactive; its primary focus
has been helping sick patients restore
their health.
Most outcomes-based healthcare
definitions center on a reactive approach to
healthcare—curing diseases, for example.
Operating in reactive mode, health
systems continuously ask, “Did we
cure that sepsis patient?” or “Did we
properly treat that heart failure patient?”

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Why Outcomes-Based Healthcare Is The Ultimate Goal
In outcomes-based healthcare, the focus
is on reducing variation in how a variety of
diseases and conditions are treated.
The process requires all clinicians to
provide accurate diagnoses and treatment
algorithms to improve patient outcomes.
Health systems are constantly striving to
overcome inefficiencies and provide high
quality care to patients.

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Why Outcomes-Based Healthcare Is The Ultimate Goal
Although improving the way health
systems care for sick patients is vital, it is
not the only goal of outcomes-based
healthcare—solely focusing on improving
health system inefficiencies is myopic.
Outcomes-based healthcare also targets a
more proactive approach to healthcare:
creating a healthcare system that strives
to maintain healthy populations and
prevent illness.

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Why Outcomes-Based Healthcare Is The Ultimate Goal
Embracing the proactive aspect of outcomes-
based healthcare leads health systems to
consistently ask several questions:
How do we maintain the health of our
patient populations?
How do we prevent illness and keep
individuals out of the hospital?
How do we operate outside our system
walls to optimize community healthcare?
How do we incorporate population health
into our business model?
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Top Three Challenges in Making the Switch to
Outcomes-Based Healthcare
If transitioning to outcomes-based healthcare
was easy, every health system would have
done it by now.
Although many systems are well on their way,
no health system has successfully completed
the switch to outcomes-based care.
Health systems struggling to make the
transition face three similar challenges:
1. Limited Analytics Capabilities
2. Limited Access to Information
3. Inappropriate Organizational Structure

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Challenge #1: Limited Analytics Capabilities
Many health systems are healthcare data rich
and analytics poor. To succeed in outcomes-
based healthcare, health systems need the
analytics capabilities to make data actionable.
At the very least, systems need the ability to
measure performance against outcomes
goals, and the effectiveness of their outcomes
improvement strategies.
The lack of analytics and the resulting inability
to evaluate performance and processes are
barriers to health systems trying to move away
from FFS models.

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Challenge #2: Limited Access to Information
Health systems need to get data into the
hands of frontline staff. Health systems
can’t change how they care for patients
unless they equip frontline staff with
information; the data-driven insights
needed to improve outcomes.
From pharmacy to claims data, clinicians
need access to the right information to
effectively manage patient populations.
Aggregating and distributing information
requires the technology infrastructure and
support most health systems don’t have.

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Challenge #3: Inappropriate Organizational Structure
Without an effective organizational
structure in place, organizations struggle
to combat the inertia inherent in systems
that have been delivering care in the
same FFS way for decades.
Healthcare leaders won’t transition their
systems to outcomes-based healthcare
unless they provide their organizations
with realistic strategies and step-by-step
guides for making incremental changes.

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The Top Outcomes-Based Healthcare Success Factors:
Health systems successfully navigating the
transition to outcomes-based healthcare
have two common denominators:
Analytics
Multidisciplinary teams
Although the transition requires more than
just the right teams armed with the right
information, these are critical first steps
when making the switch.
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The Top Outcomes-Based Healthcare Success Factors:
Analytics
The Texas Children’s success story
(described later) is an example of how
aggregating data into an enterprise data
warehouse (EDW) and putting that data
into the hands of the multidisciplinary
team responsible for spearheading
improvements are the essential
ingredients for the outcomes-based
healthcare transition.

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The Top Outcomes-Based Healthcare Success Factors:
Multidisciplinary Teams
Successful systems establish and
empower multidisciplinary teams to be
agents of change, responsible for
continuously improving targeted care
processes.
A team-based approach to outcomes-
based healthcare leverages the expertise
and influence of key stakeholders
throughout the organization.

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The Top Outcomes-Based Healthcare Success Factors:
Multidisciplinary Teams
Outcomes-driven teams typically consist of
key members:
Clinician lead (most commonly a physician or
someone with domain expertise)
Nurse or administrative champion (someone who
can make administrative changes)
Data analyst (someone who can use data to ask
and answer questions)
Representatives from other key stakeholders in
the targeted care process

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The Top Outcomes-Based Healthcare Success Factors:
Multidisciplinary Teams
These teams lead the implementation and
measurement of improvement efforts.
The critical characteristic of an outcomes-
driven team is that it’s permanent and
dedicated to continuous improvement.
Once health systems achieve their desired
improvements (for example, a reduction in
30-day heart failure readmissions),
outcomes-driven teams work to sustain
the improvements.

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An Outcomes-Based Healthcare Success Story:
Texas Children’s Hospital
Making the switch to outcomes-based
healthcare comes with inevitable yet
surmountable challenges.
Texas Children’s, a not-for-profit health
system consistently ranked among the
top children’s hospitals in the nation, has
had measurable, sustained success in its
transition to outcomes-based healthcare.

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An Outcomes-Based Healthcare Success Story:
Texas Children’s Hospital
By aggregating data into an EDW,
running targeted analytics on that data,
and putting multidisciplinary teams in
place to spearhead change, Texas
Children’s has made significant quality
and cost improvements.
Texas Children’s has improved physician
productivity and decreased length of stay
(LOS) while generating $74 million in
operational improvements.

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An Outcomes-Based Healthcare Success Story:
Analytics in Action
Texas Children’s first significant success
came as a result of analyzing data; it
discovered significant cost variation in
asthma care.
Drilling down into the X-ray data, they
discovered that physicians were ordering
chest X-rays for 65 percent of their asthma
patients—evidence-based practice calls for
an X-ray in only 5 percent of cases.
The team achieved a dramatic 46 percent
reduction in unnecessary chest X-rays.

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An Outcomes-Based Healthcare Success Story:
Multidisciplinary Teams in Action
Texas Children’s leaders established a
multidisciplinary team consisting of
physicians, nurses, and experts in patient
safety, quality improvement, finance, and IT.
Leaders tasked this team with assessing
and managing acute asthma from the time
of arrival in the ED to discharge. The team
was responsible for improving asthma care
across all hospital facilities.

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An Outcomes-Based Healthcare Success Story:
Multidisciplinary Teams in Action
Texas Children’s clinical improvement
team’s work didn’t end with its asthma
care outcomes improvement.
As a result of owning outcomes improve-
ment for asthma care, the team has long-
term responsibility for sustaining
excellence in other care processes.
The team also took on reducing the delay
between the time a child walks into the
ED and the time he or she receives the
appropriate asthma medications.

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Leading Health Systems Prioritize Outcomes-Based
Healthcare and Upstream Health
Truly mature health systems will transition
to outcomes-based healthcare and,
eventually, upstream health, in which
genomic and epigenetic factors are
incorporated into the patient care model.
A successful transition to upstream health
requires access to and analysis of new
sources of data, and the implementation
of meaningful predictive analytics to care
for patients and prevent disease from
occurring in the first place.

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Leading Health Systems Prioritize Outcomes-Based
Healthcare and Upstream Health
When health systems integrate the two
common denominators of success:
analytics infrastructure and empowered
multidisciplinary teams, they can overcome
the challenges of converting to outcome-
based healthcare.
By starting small—focusing on one
improvement area and identifying a
capable and enthusiastic team, health
systems can transition to outcomes-based
healthcare with the same measurable
success as Texas Children’s.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
The Top Success Factors for Making the Switch to Outcomes-Based Healthcare
Why a Patient-centric Approach Is Best: Stories from a Physician
Dr. Bill Knowles, Senior Director of Client Engagement
7 Features of Highly Effective Outcomes Improvement Projects
Brant Avondet, Vice President of Client Operations
Improving Healthcare Outcomes: Keep the Triple Aim in Mind
Michael Barton, Engagement Executive, VP; Tracy Vayo, Director, Knowledge Development
Kathleen Merkley, Clinical Improvement – Vice President
Michael Porter and Others Show How to Deliver Better Care in Value-based Healthcare Documentary
Paul Horstmeier, Senior Vice President
The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement
Bobbi Brown, Vice President of Financial Engagement; Jared Crapo, Sales, VP

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Bryan Oshiro, MD, joined Health Catalyst in January 2014 as the Medical Director. He
received his medical degree and completed his residency in Obstetrics and Gynecology at
Loma Linda University School of Medicine and completed his fellowship in Maternal-Fetal
Medicine at the University of Texas in Houston before moving to Salt Lake City to join
Intermountain Health Care and served as the Medical Director of the Women and Newborn
Service line. He also was a member of the department of Obstetrics and Gynecology at the University
of Utah. He then joined Loma Linda University where he became the division director of Maternal-Fetal
Medicine and the vice-chairman for the department of Obstetrics and Gynecology. He co-chairs the
American College of Obstetricians and Gynecologists Patient Safety Committee for District IX and
received the Elaine Whitelaw Service Award from the March of Dimes for his work on a 5 state initiative
to eliminate elective deliveries less than 39 weeks gestation.
Other Clinical Quality Improvement Resources
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